Predictive value of systemic immune-inflammation index and serum lactoferrin for postoperative survival in older patients with colon cancer

doi:10.4240/wjgs.v17.i11.110879

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Nov 27, 2025 (publication date) through Nov 25, 2025

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Publication Name

World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

World J Gastrointest Surg. Nov 27, 2025; 17(11): 110879
Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.110879

Table 1 General patient characteristics

Project	Value or n (%)	*χ²/t*	P value
Age (years)	72.46 ± 6.02	-	-
Sex (male/female)	36 (58.06)/26 (41.94)	1.161	0.281
BMI (kg/m²)	22.53 ± 2.28	-	-
Smoking history (yes/no)	27 (43.55)/35 (56.45)	0.968	0.325
Drinking history (yes/no)	23 (37.10)/39 (62.90)	1.419	0.234
Hypertension (yes/no)	25 (40.32)/37 (59.68)	2.258	0.133
Diabetes (yes/no)	15 (24.19)/47 (75.81)	1.613	0.204
Coronary heart disease (yes/no)	8 (12.90)/54 (87.10)	0.645	0.422
COPD (yes/no)	5 (8.06)/57 (91.94)	0.218	0.641
Tumor size (cm)	4.73 ± 1.21	-	-
TNM staging (II/III)	26/36	0.95	0.331
Degree of differentiation (high/medium/Low)	13/34/15	2.323	0.313
Neural/vascular invasion (yes/no)	19 (30.65)/43 (69.35)	1.774	0.183
NEU (× 10⁹/L)	4.12 ± 1.08	-	-
LYM (× 10⁹/L)	1.64 ± 0.42	-	-
PLT (× 10⁹/L)	212.36 ± 54.27	-	-
SII	869.42 ± 211.57	-	-
LF (μg/mL)	3.89 ± 0.86	-	-
ECOG performance status (0-1/≥ 2)	48 (77.4%)/14 (22.6%)	Calculated	Calculated
Charlson comorbidity index	3.2 ± 1.1	-	-
Adjuvant chemotherapy	51 (82.3%)	-	-
FOLFOX regimen	33 (65% of chemo)	-	-
CAPOX regimen	18 (35% of chemo)	-	-
MSI-H status	9 (14.5%)	Calculated	Calculated

P < 0.05 indicated significant difference. SII: Systemic immune-inflammation index; TNM: Traditional tumor, node, metastasis; BMI: Body mass index; COPD: Chronic obstructive pulmonary disease; NEU: Neutrophil; LYM: Lymphocyte; PLT: Platelet; LF: Lactoferrin; ECOG: Eastern Cooperative Oncology Group performance status.

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Table 2 Routine blood test and systemic immune-inflammation index

Detection period	NEU (× 10⁹/L)	LYM (× 10⁹/L)	PLT (× 10⁹/L)	SII	SII high/Low ratio (%)	t	P value
Preoperative 7 days	4.12 ± 1.08	1.64 ± 0.42	212.36 ± 54.27	869.42 ± 211.57	85/15	1.422	0.234
Postoperative 1 week	3.95 ± 1.02	1.60 ± 0.40	210.58 ± 52.73	864.25 ± 215.48	83/17	0.876	0.412
Postoperative 1 month	3.80 ± 1.05	1.55 ± 0.38	208.12 ± 50.96	854.62 ± 206.93	81/19	1.242	0.302
Postoperative 3 months	3.60 ± 1.10	1.50 ± 0.35	205.37 ± 49.12	838.41 ± 198.74	80/20	1.061	0.375

P < 0.05 indicated significant difference. SII: Systemic immune-inflammation index; NEU: Neutrophil; LYM: Lymphocyte; PLT: Platelet.

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Table 3 Serum lactoferrin

Detection period	LF concentration (μg/mL)	Low/high ratio of LF (%)	χ²/t	P value
Preoperative 3 days	3.89 ± 0.86	22/74	2.21	0.137
Postoperative 1 week	3.75 ± 0.80	25/71	5.432	0.03
Postoperative 1 month	3.55 ± 0.78	30/66	6.512	0.012
Postoperative 3 months	3.48 ± 0.79	32/64	7.234	0.008

P < 0.05 indicated significant difference. LF: Lactoferrin.

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Table 4 Liver and kidney function indicators

Detection period	ALT (U/L)	AST (U/L)	ALB (g/L)	TBIL (μmol/L)	Cr (μmol/L)	BUN (mmol/L)	χ²/t	P value
Preoperative 1 week	32.46 ± 4.21	28.72 ± 5.65	38.56 ± 6.89	12.34 ± 3.45	89.21 ± 10.34	4.91 ± 1.12	1.563	0.112
Postoperative 1 week	42.78 ± 7.13	40.13 ± 8.21	33.48 ± 5.67	16.45 ± 4.32	95.65 ± 12.56	5.34 ± 1.32	3.972	0.032
Postoperative 1 month	38.56 ± 5.02	35.97 ± 6.15	35.12 ± 4.76	14.02 ± 2.54	92.48 ± 9.87	5.12 ± 1.04	2.456	0.045
Postoperative 3 months	36.21 ± 6.01	33.84 ± 5.75	36.68 ± 5.12	13.21 ± 3.15	90.71 ± 11.21	4.87 ± 1.21	2.891	0.039

P < 0.05 indicated significant difference. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALB: Albumin; TBIL: Total bilirubin; Cr: Creatinine; BUN: Blood urea nitrogen.

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Table 5 Inflammation and nutrition-related indicators

Detection period	CRP (mg/L)	PAB (mg/L)	CRP low/high ratio (%)	PAB low/high ratio (%)	χ²/t	P value
Preoperative 3 days	8.23 ± 2.45	160.23 ± 20.34	80.65/19.35	29.03/70.97	3.561	0.062
Postoperative 1 week	12.56 ± 3.15	145.87 ± 18.76	69.35/30.65	50.00/50.00	4.23	0.027
Postoperative 1 month	9.45 ± 2.89	150.12 ± 22.45	74.19/25.81	45.16/54.84	2.893	0.089
Postoperative 3 months	6.78 ± 1.87	155.34 ± 19.53	84.68/15.32	35.48/64.52	5.114	0.01

P < 0.05 indicated significant difference. CRP: C-reactive protein; PAB: Prealbumin.

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Table 6 Tumor markers

Detection period	CEA (ng/mL)	CA19-9 (U/mL)	CEA positive proportion (%)	CA19-9 positive proportion (%)	χ²/t	P value
Preoperative 7 days	4.72 ± 1.08	28.34 ± 10.47	14.52	9.68	2.324	0.13
Postoperative 1 week	5.38 ± 1.34	32.61 ± 11.32	18.38	12.9	3.126	0.075
Postoperative 3 months	4.96 ± 1.24	30.22 ± 9.88	15.32	11.29	2.812	0.097
Postoperative 6 months	6.13 ± 1.52	36.19 ± 12.78	22.58	18.55	4.214	0.04

P < 0.05 indicated significant difference. CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9.

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Table 7 Analysis results area under the curve area under the curve

Indicator	Cut-off value	Sensitivity (%)	Specificity (%)	AUC	95%CI	Youden's index
SII	650	78	71	0.75	0.68-0.82	0.49
LF	200	70	65	0.72	0.65-0.79	0.35
CRP	10	66	72	0.74	0.68-0.80	0.38
CEA	5	80	60	0.73	0.67-0.79	0.4
CA19-9	37	65	78	0.72	0.66-0.78	0.43

AUC: Area under the curve; SII: Systemic immune-inflammation index; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; CRP: C-reactive protein; LF: Lactoferrin.

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Table 8 Confusion matrix for systemic immune-inflammation index (cut off = 585)

Death	Survival
High risk	18	5
Low risk	7	32
Overall accuracy: 80.6%

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Table 9 Results of logistic regression analysis

Analysis type	Factor	β	SE	χ²	P value	OR	95%CI
Single factor	SII (> 650)	1.35	0.48	7.85	0.005	3.85	1.52-9.69
	LF (> 200)	1.12	0.49	5.33	0.021	3.07	1.26-7.46
	CRP (> 10)	0.95	0.52	3.24	0.072	2.59	0.95-7.04
	CEA (> 5.0)	1.27	0.54	5.61	0.018	3.55	1.19-10.46
	CA19-9 (> 37)	0.83	0.47	3.17	0.075	2.29	0.92-5.71
	Constant	-1.05	0.45	5.444	0.02	-	-
Multiple factors	SII (> 650)	1.23	0.48	6.5	0.011	3.42	1.39-8.39
	LF (> 200)	0.96	0.49	4.12	0.043	2.61	1.04-6.53
	CEA (> 5.0)	1.05	0.51	4.25	0.039	2.86	1.06-7.66
	Constant	-0.87	0.42	4.29	0.038	-	-

P < 0.05 indicated significant difference. SII: Systemic immune-inflammation index; CEA: Carcinoembryonic antigen; CA19-9: Carbohydrate antigen 19-9; CRP: C-reactive protein; LF: Lactoferrin.

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Table 10 Results of logistic regression analysis

Analysis type	Factor	β	SE	χ²	P value	HR	95%CI
Single factor	SII (> 650)	0.88	0.29	9.21	0.002	2.41	1.35-4.29
	LF (> 200)	0.7	0.28	6.25	0.012	2.02	1.17-3.49
	CEA (> 5.0)	0.66	0.3	4.85	0.028	1.93	1.07-3.47
	TNM stage III	1.02	0.29	12.39	0	2.78	1.52-5.07
	Age ≥ 65 years old	0.43	0.32	1.8	0.179	1.53	0.81-2.89
Multiple factors	SII (> 650)	0.88	0.32	7.56	0.006	2.41	1.30-4.46
	LF (> 200)	0.7	0.31	5.1	0.024	2.02	1.10-3.70
	TNM stage III	0.99	0.31	10.2	0.001	2.69	1.44-5.02

P < 0.05 indicated significant difference. LF: Lactoferrin; SII: Systemic immune-inflammation index; TNM: Traditional tumor, node, metastasis; CEA: Carcinoembryonic antigen.

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Table 11 Biomarker quality control data

Parameter	Value (%)
Intra-assay CV	4.20
Inter-assay CV	7.60
Recovery rate	95-105

CV: Coefficient of variation.

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Citation: Zhu SS, Yang T, Cheng LL. Predictive value of systemic immune-inflammation index and serum lactoferrin for postoperative survival in older patients with colon cancer. World J Gastrointest Surg 2025; 17(11): 110879
URL: https://www.wjgnet.com/1948-9366/full/v17/i11/110879.htm
DOI: https://dx.doi.org/10.4240/wjgs.v17.i11.110879